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Oxford, UK: National Health Service (NHS); October 2008. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Policy Statement 6d: Aesthetic surgery procedures. There were 18 out of 415 studies eligible to review. Wound drainage after plastic and reconstructive surgery of the breast. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. text-decoration: line-through; Endocrinol Metab Clin North Am. Plastic Reconstruct Surg. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. } 2016;20(3):256-260. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Major complications (1.6 %) included unilateral hematoma and localized infection. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Annu Rev Med. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. color: blue!important; Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Plast Reconstr Surg. Qu S, Zhang W, Li S, et al. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 2006;118(4):840-848. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. } Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Fagerlund A, Cormio L, Palangi L, et al. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Breast J. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. border: none; Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. Plast Reconstr Surg. Plast Reconstr Surg. 1999;103(6):1682-1686. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. In: Townsend CM, Beuchamp RD, Evers BM, eds. The risks included infection, wound breakdown, scarring, and the need for re-operating. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". list-style-type: lower-roman; American Society of Plastic Surgeons (ASPS). Brown DM, Young VL. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. Risk factors for complications following breast reduction: Results from a randomized control trial. 2005;55(3):227-231. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Arlington Heights, IL: ASPS; March 9, 2002. Laituri CA, Garey CL, Ostlie DJ, et al. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. Management of gestational gigantomastia. Li CC, Fu JP, Chang SC, et al. American Society of Plastic Surgeons (ASPS). } The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Gynaecomastia. The mean age was 42.8 years (SD 19.5 years). OL OL LI { Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. 1995;95(1):77-83. Tang CL, Brown MH, Levine R, et al. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. The majority (87.7 %) of cases presented with accompanying mastalgia. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. color: white; Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Nguyen JT, Wheatley MJ, Schnur PL, et al. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. In these cases, breast reduction for men may take 2 to 3 hours. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Reduction mammaplasty: An outcome study. border-radius: 4px; The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Plastic surgery for teenagers briefing paper. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. /* aetna.com standards styles for templates */ In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. Br J Plast Surg. Reduction mammoplasty for macromastia. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Yao Y, Yang Y, Liu J, et al. 2007;119(4):1159-1166. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Fagerlund A, Lewin R, Rufolo G, et al. Petty PM, Solomon M, Buchel EW, Tran NV. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Oxfordshire NHS Trust. 1997;100(4):875-883. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 2006;9(2):109-114. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2).